Medical marijuana in Louisiana: when?

The state approves medical marijuana for some illnesses — but prescriptions are years away

Wrapped in a blue cardigan, Michele Hall pulled out several large bottles of prescription medicines from a clear plastic bag and placed them on the table in front of a silent Louisiana House Committee on Health and Welfare. Her 4-year-old adopted daughter, Elle Grace, has suffered chronic seizures since she was 1. There are twice-daily doses of Depakote and Trileptal to keep the seizures at bay, Prozac to counteract the Depakote, and Risperdol, and then Zantac to combat the constant acid reflux.

Hall said her daughter would only need one drug to cut the child's medication routine in half — but medical marijuana isn't legal in Louisiana, despite several attempts to make it so over the last 40 years. The Hall family may move to Colorado where doctors can prescribe a refined cannabis oil to treat Elle Grace.

"That's the harsh reality of what I'm trying to get you to say 'yes' to," she told the committee on May 27. "[Elle Grace is] going to be clear-minded. She's going to be a happy little girl."

That "yes" came with passage of a bill by Republican state Sen. Fred Mills, a soft-spoken Cajun pharmacist from St. Martin Parish with a thin face and a pad of gray-flecked hair. At that committee hearing, he slouched in a chair, rocking, his suit looking a size too big — not quite the picture of a man one might expect to see leading a years-long battle to get the state to authorize the use of medical marijuana.

Mills' measure cleared the committee — and it passed the House and the Senate. In June, Gov. Bobby Jindal signed it into law. The Alison Neustrom Act — named after a Lafayette Parish sheriff's daughter who died of cancer in 2014 — tasks several statewide agencies with drafting the rules for planting, cultivating, dispensing, prescribing and ingesting medical marijuana in Louisiana.

Doing any of those things right now is illegal. When Louisiana is still light years from the end of marijuana prohibition, how will the state grow and dispense a drug still listed by the feds as a Schedule I controlled substance that's illegal to possess or use?

"I think the next 12 months of development and rule writing and making everybody comfortable with what we're doing ... there's a lot to prove before we move forward," Mills says. "I'm optimistic, but there's a lot of things that have to go right."

The O.G.

In 1978, a Morgan City Democratic state senator introduced a bill to allow medical marijuana in Louisiana. None of state Sen. Tony Guarisco's constituents had asked him for it, and his companion bill to decriminalize pot possession was laughed out of the Senate.

"It got nine votes," Guarisco remembers. "When you only get nine votes, you remember 'em." (More than three decades later in 2011, the New Orleans City Council adopted a similar citywide decriminalization ordinance.) Guarisco's medical marijuana bill was signed into law by then-Gov. Edwin Edwards in July 1978.

"I thought people ought to be able to access whatever medicine they can get," he says. "That's basically what it was. I must've hit a sweet spot. I don't remember any particular polls, but if there were polls, I'd imagine the majority were against doing anything with that."

Guarisco's bill allowed doctors to prescribe marijuana for "therapeutic use" to treat glaucoma, chemotherapy side effects and spastic quadriplegia, and it created the Marijuana Control Board — to which no one ever was appointed. Ten years later, then-Gov. Buddy Roemer killed the board, among a dozen other "inactive" boards. There was never any framework to legally get marijuana into patients' hands.

"It died from benign neglect," Guarisco says. "They didn't enforce it. That was the beginning of the end."

But in 1991, state legislators made another attempt to legalize marijuana — under the condition that doctors register with the federal Drug Enforcement Administration (DEA).

"There was a bill that had a poison pill in it," Guarisco says. "The DEA was never going to do that. That was dead in the water by pure existence." (In May 2015, Mills chastised members of a House committee who considered putting a similar amendment in his bill. If the legislation languished while they waited for a federal ruling, "shame on us," he told them.)

Mills says he receives dozens of calls every year from doctors looking for some kind of loophole in state law that would allow them to prescribe marijuana to patients looking for relief. Despite a medical marijuana law idling in the law books, there is nowhere in Louisiana to get a prescription filled, much less legally written, and waving a "prescription" for pot at a police officer isn't likely to hold water before an arrest. In 2014, Mills introduced his bill.

At a meeting of the Senate's Health and Welfare Committee last year, Alison Neustrom told legislators how current treatments for her cancer had devastating side effects. Marijuana, she said, should be an option. "Make the compassionate vote, the courageous vote and moral vote," she said.

State prosecutors and law enforcement officials pressured the committee to hold off on a vote, at least until
a federal ruling was made. The committee agreed.

Neustrom died later that year.

Hashing it Out

"I get a lot of calls, even angry calls from folks thinking this was total legalization like in Colorado," Mills says, "or they thought it was like Colorado and were excited about it."

The Alison Neustrom Act hands the future of medical weed in Louisiana to a handful of state agencies, including the state Department of Agriculture & Forestry, which will write the guidelines for growing; the state Board of Medical Examiners, which will regulate how it's prescribed; and the Louisiana Board of Pharmacy, which will write the rules for dispensing.

The agricultural centers at Louisiana State University (LSU) and Southern University have the first right of refusal to grow the state's crop. If either agrees to do so, that AgCenter will be the sole provider for the state's entire pharmaceutical-grade medical marijuana stock. The universities' boards of supervisors ultimately will decide whether the AgCenters will go for it: There are several campuses and farm sites throughout the state but no plans yet for a pot farm. Until the Department of Agriculture & Forestry establishes those guidelines, "we're kind of in limbo," says Frankie Gould of the LSU AgCenter. Agriculture & Forestry also must determine the size of the site, but it doesn't know the volume it will need to produce. The law also allows for 10 dispensaries throughout the state, but where they'll go, who's eligible to dispense and how pharmacies and companies can apply for permitting have not been determined.

Photo illustration by David Kroll

The law is deliberately narrow in scope. Mills says it was his best shot at getting something passed to get the wheels moving and the state's powerful law enforcement lobby to at least agree not to oppose it.

One thing is certain: Smoking weed is off the table even for medicinal purposes, since the law prohibits "inhalation" of "raw or crude" pot. The law currently allows a refined cannabis-based oil, which can be dispensed with an eyedropper, but has little if any THC, which produces the "high" associated with smoking pot.

“People ought to be
able to access whatever medicine they can get.” – former state senator Tony Guarisco

And the law covers only a few diseases, specifically glaucoma, spastic quadriplegia and cancer, if the patient is undergoing chemotherapy.

"That's the major thing that blows my phone up," Mills says. "The biggest question mark, and the most questions I get, is 'Why not this disease? Why not HIV?' ... [Patients can] have that conversation with their physician, let their physician become involved in it. If the physician thinks this therapy [is appropriate] for this disease state, they can communicate that back to their board. ... Ultimately it's going to have to be the doctor authorizing the medication."

The state already has a prescription monitoring program to prevent abuse, and Mills says that also will be enforced with the new law to track who's dispensing, where it's going and ensure "a robust way of tracking from seed to product."

"You don't want a lot of doctor shopping, multiple locations being used (to acquire a prescription)," he says. "We've got the formula. We've done it before. It's just incorporating it together."

Louisiana has one of the highest rates of prescription pain medication abuse in the U.S. and the 19th highest rate of drug overdose deaths, mostly from prescription medicines, according to a 2013 report from the Trust for America's Health.

"I would much rather my physician prescribe for me the refined medical marijuana oil than Oxycontin or Loritabs or Tylox or Percodan," Mills says.

Mills' early concept for the prescription process would go like this: Doctors who want to prescribe marijuana would need a separate license and prescription pad, redeemable only at dispensaries with a special permit. "By doing that with two separate permits and separate licenses, we've given legal authority for that physician and dispensary solely for medical marijuana," he says.

All these guidelines can change next year — from the type of weed available to who can get it. The bill allows a 60-day window for the state agencies charged with the guidelines to ask legislators to update the law with new recommendations. The Department of Agriculture anticipates turning in its growing guidelines to legislators as early as January.

Four states — Alaska, Colorado, Oregon and Washington — have legalized marijuana for personal use, and 18 other states have taken steps toward allowing its medical use. Mills doesn't want to confuse Louisiana's baby steps with a sprint toward full-blown legalization.

"Much younger generations are like, 'This is great! When's it going to happen?' Then I got calls from people in their 70s who think it's a gateway (to other drugs) and it's horrible," he says. "When I've had a chance to explain the medicinal purposes of the bill, it's been very well-received, but I don't think Louisiana is ready to go down that Colorado route until at least a lot is proven on this side. You wouldn't believe some of the talks I've given — there's people clapping for me thinking I legalized marijuana, then there's people booing, because they think I legalized marijuana."

Strained

Mike Strain has a seed problem.

Strain, Louisiana's commissioner of Agriculture and Forestry, is starting from scratch with an illegal product, and he's looking at 20 states (including Colorado) for help in writing rules and regulating, processing and distributing marijuana — safely and with tremendous oversight. Even with layers of safeguard, the process is likely to draw federal scrutiny.

But first he has to figure out where to get seeds.

"We have to produce a pharmaceutical-grade product and we don't have any seeds, much less plants," he says. "Think about logistics: Where are you going to get the seeds from? When you grow out that first batch of seeds, you have to have sufficient amount of seeds to produce a plant, a crop. We don't have any seeds. We're talking about the end product, but where are you going to get the seeds?"

Legislators handed responsibility to university AgCenters for practical reasons — they have professional medical research teams, scientists and experts, who already study and engineer dozens of Louisiana crops — as well as for liability. The state won't be doing the growing. However, putting universities in charge of an illegal drug without federal approval could put them at risk when it comes to receiving federal funding. Mills says it shouldn't be a problem.

"There have been rulings by the DEA, by the Department of Justice, that if states have determined medical marijuana is legalized, they would basically let those states decide what to do and not be involved with it," he says. "It's still a Schedule I [drug] theoretically, but when it's purely medicinal and the THC levels have been dropped, and the federal government is being forthright and honest, then law enforcement shouldn't be an issue."

LSU already is performing marijuana research. This year, Dr. Chu Chen of LSU Health Sciences Center New Orleans received nearly $500,000 from CB BioSciences to study the impact of THC on neurodegenerative diseases like Alzheimer's and Parkinson's disease. The company then will license and sell the results.

Potholes

Meanwhile, as state agencies meet to discuss guidelines for the new law, people with a prescription for pot — procured from and filled in states where it has been legalized — can't legally bring it into Louisiana.

"They're breaking federal law," says New Orleans criminal defense attorney Craig Mordock. "This is an important first step ... but being Louisiana, this isn't going to be like California where anyone can get a prescription. They're going to keep a tight lid on this."

Guarisco says there are too many agencies involved with the process, which could invite dozens of arguments, all presenting different problems to legislators and ultimately stifling the law or even killing it.

"I think it's sort of like pinning down Gulliver with a lot of Lilliputians," he says. "You can move, but it's going to be tough."

Guarisco also says bringing law enforcement to the table has and will continue to weaken the law. Despite legislators' attempts to lift stiff penalties for possession, law enforcement officials largely want to keep pot illegal — and jails full.

According to a 2013 report from the American Civil Liberties Union (ACLU), Louisiana's marijuana arrests rose by 10 percent over the last decade, and the state spent nearly $47 million enforcing marijuana laws in 2010 alone. This year, however, the state's ACLU, as well as sheriffs and district attorneys, supported a measure to lower penalties for marijuana possession. Jindal signed it into
law June 29.

"You never see law enforcement people wanting to remove a law," Guarisco says. "If you don't have any sins, a preacher doesn't have a church."

Jacob Irving, a 21-year-old LSU student with spastic quadriplegia, wore a dark suit to the state's Senate Committee on Health and Welfare in April. The state's 1991 medical marijuana law covers spastic quadriplegia, a debilitating type of cerebral palsy — but Irving hasn't been able to access that treatment in his home state. Other prescription medications haven't been effective, he said.

"I have trouble sleeping and just doing anything," Irving said. "Medical marijuana stigma is not helping. What's going to happen when I apply for a job and I can't move around? You think they're going to give that to someone who isn't able-bodied?"

One month later, Irving testified again, this time in the House Committee on Health and Welfare, to usher the bill's passage in the House alongside Mills.

"If we make this thing work ­— the way these legislators debated it, and LSU and Southern AgCenters are involved, see if we can get the pharmacies involved and LSU involved and get a lot of science behind it and it becomes successful — you just never know," Mills says. "If we don't get the right parties involved and the rule making correct, this may just be the end."